MP48-15: Is there a role for surgical treatment in patients with Parkinson's disease and benign prostatic obstruction?

benoit peyronnet, gregory vurture, victor vanalderwerelt, francois tariel, benjamin pradère, sebastien vincendeau, franck bruyere, romain mathieu, victor nitti, benjamin brucker

Introduction: The aim of the present study was to assess the outcomes of benign prostatic obstruction (BPO) surgical treatment in Parkinson’s Disease (PD) patients.

Methods: All male patients with a reliable diagnosis of PD who underwent transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP) for bothersome lower urinary tract symptoms (LUTS) due to BPO between 2010 and 2017 at 3 academic institutions were included in a retrospective study. Patients with doubtful neurological diagnosis (i.e. parkinsonism not formally diagnosed as PD) were excluded.  The primary endpoint was clinical success defined as any subjective improvement in LUTS self-assessed by the patients 3 months after TURP or PVP or recovery of spontaneous voiding in patients with refractory urinary retention preoperatively.

Results: 42 PD patients were included: 31 and 11 treated with PVP and TURP respectively. The mean follow-up was 22.4 months. At 3 months, 29 patients reported their LUTS had improved (69%), eight that they were unchanged (19.1%) and nine that they were worsened (11.9%). Ten of the 14 patients with an indwelling catheter preoperatively recovered spontaneous voiding (71.4%). In patients voiding spontaneously preoperatively, the mean number of nocturia episodes significantly decreased at 3 months (from 3.7 to 2.1 per night; p=0.04) and so did the post-void residual volume (from 138 to 63.9 ml; p=0.008). Fourteen patients (33.3%) required overactive bladder treatments for storage LUTS postoperatively. Out of 16 patients with preoperative incontinence, seven experienced a complete resolution of their incontinence postoperatively (43.8%). Conversely, out of 26 patients with no incontinence preoperatively, three patients reported de novo urinary incontinence lasting over 6 months postoperatively (11.5%). Overall the success rate was higher in those with urodynamically proven bladder outlet obstruction (BOO) (90.9% vs. 61.3%; p=0.07). There was no de novo incontinence in this subgroup and only one reported worsened symptoms post-operatively (8.3%). BOO index was significantly associated with success (p=0.04)

Conclusions: TURP/PVP provide satisfactory outcomes in PD patients with BPO overall. However, the relatively high rates of patients with worsened symptoms (11.9%) and de novo incontinence (11.5%) postoperatively stress the need for careful patients’ selection and appropriate counseling. Urodynamically proven BOO may lower these two risks. Source of

Funding: none